Cancer can develop in several structures in the eye area. These include:
Eyeball: The structures inside the eye where cancer can develop include the choroid, ciliary body, iris and retina.
Uvea is the middle layer of the eyeball. It contains the:
- Iris: The colored part of the eye. The pupil, a small opening that lets light come into the eyeball, is in the middle of the iris
- Choroid: Thin layer around the eyeball that provides the eye with blood
- Ciliary body: Made up of muscles inside eye that help it focus and cells where aqueous humor (clear liquid in front of eye) begins
- Retina: The layer of cells in the back of the eye. The retina is connected by the optic nerve to the brain. Its cells are sensitive to light and help us see images. When light comes into the eye, it passes through the lens. This makes an image on the retina, which is then sent by the optic nerve to the brain.
Orbit: The space around and behind the eye has bony walls and contains important nerves, including the optic nerve, and muscles that move the eye.
Eyelid: Tumors that affect eyelids can be on the skin of the eyelid or on the inside layer of the eyelid (tarsus and conjunctiva).
Conjunctiva: Surface covering of the eye that also covers the inside of the eyelid
Lacrimal gland: The gland, which makes tears, is in the upper outer quadrant of the orbit.
Lacrimal sac/duct: This structure, which drains the tears, is in the inner lower quadrant of the orbit near the nose.
Squamous cell carcinoma: This is the most frequently occurring type of conjunctival eye cancer. It can affect the area around the cornea on the eye surface or the inside conjunctival layer of the eyelids. It has a very low risk of spreading to the lymph nodes.
This eye cancer is most often treated with surgery with preservation of the eye. Supplemental cryotherapy (freezing treatment) is given to the edges of surgical area at the time of surgery. Sometimes topical chemotherapy (chemo drops) are used after surgery. In aggressive recurrent cases of conjunctival squamous cell carcinoma, the eye may have to be removed.
Melanoma: Melanoma can occur on the conjunctiva on the surface of the eyeball (bulbar conjunctiva) or on the conjunctival covering of the inside of the eyelid (palpebral conjunctiva). Conjunctival melanomas have a risk of spreading to lymph nodes and to other parts of the body. This risk is higher for thicker melanomas.
Surgical removal of the tumor with cryotherapy to the surgical margins is the most common treatment. Sentinel lymph node biopsy is done to find early microscopic metastasis in the lymph nodes that drain the conjunctival melanoma (please link this to our clinical trials site for ophthalmology). This procedure helps with staging of this eye cancer and also with offering additional treatments for more advanced stages as soon as possible.
Sometimes our doctors use topical chemotherapy (chemo drops) after surgery to lessen the likelihood of recurrence. It is very important that surgeons and pathologists familiar with this rare form of melanoma do the surgery and evaluation of the surgical specimen; otherwise, there is a higher risk of recurrence and valuable information about prognosis of melanoma can be lost.
Mucosa-associated lymphoid tissue lymphoma (MALT): This form of eye cancer occurs on the surface covering of the eye and the inside layer of eyelid (conjunctiva). It is a low-grade (slow-growing) form of B-cell lymphoma that usually shows up as a salmon-colored (light orange) growth on the surface of the eye.
The first step is to biopsy the growth to confirm it is lymphoma. Evaluation of the biopsy specimen is very important. Expert pathologists at MD Anderson specialize in diagnosing conjunctival MALT lymphoma using the biopsy from the eye.
Treatments for this eye cancer may include radiation therapy or monoclonal antibody treatment or other types of chemotherapy. Our ophthalmologists work closely with medical oncologists and radiation oncologists to determine the best treatment options for each patient.
Uveal Melanoma: This is a rare type of cancer of the eye. It is the most common eye cancer in adults and accounts for about 5% of melanoma cases.
The uvea is behind the sclera (the white of the eye) and the cornea, the window at the front of the eye. The uvea has three parts, including the:
- Iris, the colored part of the eye
- Ciliary body, a ring of tissue with muscle fibers that change the size of the pupil and the shape of the lens
- Choroid, also known as the posterior uvea, is the back part of the eye under the retina
According to the American Cancer Society, about nine of 10 melanomas of the eye develop in the choroid.
Uveal Melanoma Symptoms
Uveal melanoma often does not cause symptoms, and many cases are found during routine eye exams. If you do have symptoms, they may include:
- A dark spot on the iris
- A change in the shape of the pupil
- Blurred vision or other change in vision
- Eye pain
- Eye redness
Uveal Melanoma Diagnosis
A professional eye exam is the main method used to diagnose uveal melanoma. Other diagnosis tools include ultrasound and a fluorescein angiography, which examines the blood vessels and flow of blood inside the eye.
Uveal Melanoma Treatment
The treatment for uveal melanoma depends on several factors. Treatment may include surgery, radiation, proton therapy or radiosurgery. MD Anderson also offers clinical trials for patients with uveal melanoma. Ask your doctor for more information or visit our clinical trial database.
Uveal Melanoma Prevention
Risk factors for intraocular melanoma include:
- Exposure to natural or artificial sunlight (such as tanning beds) over long periods of time
- Fair-skinned with light-colored eyes
- Advanced age
No known inherited genetic mutation is known to cause uveal melanoma. However, MD Anderson is researching families in which uveal melanoma occurs and a gene mutation known as BAP1.
Regular eye examinations by an ophthalmologist are the best way to find uveal melanoma early, when chances for successful treatment are the highest.
Retinoblastoma is the most common type of eye cancer affecting children. It has a strong genetic component and is typically diagnosed before age two. To learn more, visit our retinoblastoma disease page.
Basal cell carcinoma: More than 90% of eyelid cancers are basal cell carcinomas (cancer) of the skin. The lower eyelids are involved in more than 70% of cases, followed by the corner of the eye, upper eyelid and the side corner of the eye.
This type of eye cancer can cause significant damage to the eyelid. It can recur (come back) to the same area or nearby if the entire tumor is not removed. The tumors usually do not spread to lymph nodes or distant organs.
It is very important for an experienced and skilled surgeon to remove this type of eye cancer to have the best chance to preserve the eye and its function. At MD Anderson, our orbital and oculoplastic surgeons have remarkable expertise in removing and reconstructing the eyelid using specialized surgical reconstructive techniques. Reconstruction of the eyelid tissue is critical to preserving vision, maintaining comfort in the eye, and restoring appearance and function of the eyelid.
Squamous cell carcinoma: This skin cancer occurs less often on the eyelid than basal cell carcinoma, but it is more aggressive. It can spread to nearby lymph nodes and other parts of the body.
The main treatment for this type of eye cancer is surgical removal. Radiation therapy or other treatments may be used in addition to surgery if a large area is affected or if the tumor cannot be fully removed.
As with other eyelid cancers, a reconstructive eye surgeon (oculoplastic surgeon) is key to removal and reconstruction of eyelid squamous cell carcinomas. Our ophthalmic surgeons work closely with experienced dermatopathologists to ensure all the tumor is removed before the eyelid is reconstructed.
Melanoma: This type of skin cancer accounts for about 1% of eyelid cancers. It is a potentially life-threatening type of skin cancer that can affect the eyelid skin or the conjunctiva.
MD Anderson’s ophthalmic surgeons pioneered sentinel lymph node biopsy for eyelid and conjunctival melanomas (please link this to our clinical trials site for ophthalmology). This technique enables our doctors to find early metastasis in the nearby lymph nodes that drain an eyelid or conjunctival melanoma. Sentinel lymph node biopsy can help stage melanomas of the eyelid and conjunctiva and often can allow our doctors to offer early interventions that increase your chances for successful treatment.
Sebaceous carcinoma (meibomian gland carcinoma): Also known as sebaceous gland or sebaceous cell carcinoma, this rare type of eye cancer affects the meibomian glands of the eyelids, conjunctiva or other ocular surface structures. These glands normally produce the oily layer of the tear film, the liquid layer that covers the eye.
Sebaceous carcinoma of the eyelid can be mistaken for non-cancerous conditions like a chalazion, a small cyst known as a sty. If a sty does not heal with medical treatment or surgical drainage, a biopsy should be done.
Our surgeons have a high level of experience with this rare eye cancer because a large number of patients are referred to our center. Our doctors were the first to do sentinel lymph node biopsy for eyelid sebaceous carcinomas and are able to find early microscopic metastasis in lymph nodes draining the eyelid cancer and offer early treatments to keep it from becoming more advanced.
The sebaceous cancer in the eyelid is surgically removed, and the defect in the eyelid is reconstructed with various techniques depending on the size and location of the tumor. Sometimes topical chemotherapy (chemotherapy drops) are used after the surgical area has healed.
Merkel cell carcinoma: This uncommon but aggressive cancer of the eyelid arises from the touch receptors in the skin of the eyelid. The cancer usually shows up as a purplish or flesh-colored mass, and it usually grows rapidly.
The treatment for this type of eye cancer is surgery followed by radiation therapy. The tumor has to be surgically removed with wide margins, and the eyelid is reconstructed. A few weeks later, radiation treatment usually is delivered to the surgical area. Sentinel lymph node biopsy is an important additional procedure to consider at the time of surgical treatment.
In about 30% to 50% of patients, cancer has spread to the lymph nodes and need to be treated either surgically or with radiation therapy. For tumors larger than 20 mm (about an inch), intravenous chemotherapy may be used to prevent recurrences.
Eye Cancer Risk Factors
Anything that increases your chance of getting eye cancer is a risk factor. Certain factors seem to increase the odds you might get cancer in the eye or on the eyelid or orbital area.
- Light skin and/or blue eyes
- Exposure to sun or tanning salons may increase risk of carcinomas or melanomas on your eyelid.
- Exposure to certain viruses such as human papilloma virus (HPV) may increase the risk of squamous cell carcinoma of conjunctiva.
- Atypical mole and melanoma syndrome (AMS): Previously known as dysplastic nevus syndrome, AMS is characterized by large numbers of atypical moles.
Not everyone with these risk factors gets ocular cancers. However, if you have risk factors, it’s a good idea to discuss them with your health care provider.